South Dakota residents can still purchase nationwide PPO insurance. Around Rapid City, the marketplace PPO also costs only a little more than an EPO. Here's how Black Hills builders can compare those choices.
Hi, I'm Sam Jaber. Health insurance is what I broker, and I'm licensed in South Dakota. Everything happens over the phone, so we can talk even when you're working on a roof near Hill City.
Imagine a Rapid City contractor running a small construction crew. During spring, summer and fall, he's building and finishing houses west of town, adding rooms to cabins near Sheridan Lake and renovating rentals for visitors heading toward Mount Rushmore. Winter snow slows outdoor construction in the Hills, so he turns to kitchen renovations, basement work and preparing bids. His wife manages the finances, and their two children ski at Terry Peak. Depending on how busy the year gets, their income may qualify for premium credits or exceed the limit.
For that Rapid City contractor, nationwide PPO coverage is still an option in South Dakota. I can help arrange it for the family.
South Dakota also offers PPO coverage through its marketplace. Pennington County has 28 medical plans from 3 insurers for 2026, including 21 PPOs and 7 EPOs. For a 40-year-old comparing silver coverage without credits, the lowest-priced PPO is just 6% above the lowest-priced EPO. An EPO generally doesn't cover out-of-network care except emergencies, while a PPO pays toward outside providers at a higher cost to you and doesn't require referrals. Private nationwide PPO coverage is another option, with premiums determined through medical underwriting.
What matters is your household's projected net earnings during the coverage year. For a contractor, subtract expenses for workers, lumber, drywall, trusses, skid steer and trailer payments, permits and liability insurance from the business's billings. Make a realistic estimate, and revise it through HealthCare.gov when projects get canceled or major contracts are signed.
Enrollment for 2027 begins November 1 and ends January 15. If you want coverage effective January 1, make your selection by December 15. Most crews have finished their exterior projects by then, making it a convenient time to call.
HealthCare.gov generally offers the lowest premiums when you qualify for tax credits, since those credits can't be used elsewhere. In Pennington County, the lowest-priced PPO is only 6% more than the lowest-priced EPO before credits, so I'd seriously consider it. The credit amount comes from the second-lowest-priced silver plan rather than your selection, meaning you cover any additional premium. That modest difference provides benefits for out-of-network doctors that an EPO wouldn't cover. Still, if your doctors participate in an EPO and you seldom travel outside the Hills, the EPO may be a sensible choice.
Next step: Give me your last tax return and an estimate of this season's business activity. I'll calculate Pennington County PPO and EPO premiums with your credit included.
A busy summer can put your family above the premium credit income range. When that happens, all 28 Pennington County marketplace plans are full price, making a medically underwritten nationwide PPO worth comparing.
The application asks medical questions about everyone in your household. After reviewing them, the insurer may approve coverage, approve it with one previous condition excluded or decline the application. Healthy families can often pay less than unsubsidized marketplace rates. Nationwide access also helps when your children compete in Denver or you're visiting relatives in Minnesota.
Next step: Call me with everyone's birth year and the doctors your family uses. I'll compare nationwide PPO premiums with Pennington County's unsubsidized marketplace plans.
Straight answers, no sales pitch.
Yes. In 2026, Pennington County offers 21 marketplace medical PPOs and 7 EPOs through 3 insurers.
Without premium credits, a 40-year-old pays 6% more for the lowest-priced silver PPO than for the lowest-priced silver EPO.
No. Your credit is calculated using the second-lowest-priced silver plan, and any premium above that amount is your responsibility.
Enrollment runs November 1 through January 15. Choose by December 15 for January 1 coverage.
Tell me your county, the family members needing coverage, your regular doctors and last year's business profit. I'll compare Pennington County PPO and EPO prices after credits with a nationwide PPO quote.
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